title: Close or positive margins after surgical resection for the head and neck cancer patient: the addition of brachytherapy improves local control.
abstract: OBJECTIVE
  Microscopically positive or close margins after surgical resection results in an approximately 21-26% local failure rate despite excellent postoperative external radiation therapy. We sought to demonstrate improved local control in head and neck cancer patients who had a resection with curative intent, and had unexpected, microscopically positive or close surgical margins.
  
  
  METHODS
  Twenty-nine patients with microscopically close or positive margins after curative surgery were given definitive, adjuvant external radiation therapy and 125I brachytherapy. All 29 patients had squamous cell cancer and tonsil was the most common subsite within the head and neck region. After external radiation therapy and thorough discussions with the attending surgeon and pathologists, the slides, gross specimens, and appropriate radiographs were reviewed and a target volume was determined. The target volume was the region of the margin in question and varied in size based on the surgery and pathologic results. Once the target volume was identified the patient was taken back to the operating room for insertion of 125I seeds. Activity implanted (range 2.9-21.5 millicuries) was designed to administer a cumulative lifetime dose of 120-160 Gy.
  
  
  RESULTS
  Twenty-nine patients were followed for a median of 26 months (range 5-86 months). Two-year actuarial local control was 92%.
  
  
  CONCLUSIONS
  125I, after external radiation therapy, is an excellent method to improve local control in the subset of patients with unexpectedly unsatisfactory margins.
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Beitler
authors.forename: R V
authors.initials: RV
authors.lastname: Smith
authors.forename: C E
authors.initials: CE
authors.lastname: Silver
authors.forename: A
authors.initials: A
authors.lastname: Quish
authors.forename: S M
authors.initials: SM
authors.lastname: Deore
authors.forename: E
authors.initials: E
authors.lastname: Mullokandov
authors.forename: D P
authors.initials: DP
authors.lastname: Fontenla
authors.forename: S
authors.initials: S
authors.lastname: Wadler
authors.forename: M K
authors.initials: MK
authors.lastname: Hayes
authors.forename: B
authors.initials: B
authors.lastname: Vikram
mesh_terms: D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D018365:Neoplasm, Residual; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant
chemical_list: D007457:Iodine Radioisotopes